摘要:

The information on epidemiology of stroke in Europe comes from mortality statistics and incidence studies. The purpose of this paper was to review the data on mortality, incidence, case fatality and stroke care in Europe, and to discuss geographical and temporal trends, taking into account methodological problems. The available updated studies on mortality and incidence were reviewed. Considering methodological characteristics, incidence studies were evaluated separately for “ideal” and “nonideal” studies. The preliminary data of the ongoing EC Stroke Project were also examined. Marked differences are observed in mortality rates across European countries. Rates are higher in Eastern compared to Western countries. Temporal trends are decreasing in Western and increasing in Eastern countries. Incidence data are scanty and probably not fully representative. Preliminary observations show that marked differences exist in stroke care across different countries. Geographical and temporal trends in mortality and morbidity may reflect both methodological inhomogeneity and differences in prevalence of risk factors, incidence and survival. Differences in socio‐economical level may have an impact on stroke care, and may indirectly influence stroke frequency measures. A collaborative effort is needed for standardizing the methodologies, checking the reliability of data, and examining more extensively trends in risk factors and stroke care. This may make it possible to optimize the cost effectiveness of management of stroke patients

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00097.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In addition to motor impairment, non‐demented patients with Parkinson's disease (PD) exhibit a variable degree of cognitive impairment which could indicate dysfunction in the central executive of working memory. In this study, we have employed positron emission tomography measurements of resting brain glucose metabolism (CMRglc) to investigate the neural substrates underlying this dysfunction, taking PD as a model disease to assess, within the framework of Alexander's striato‐pallido‐thalamo‐cortical cognitive circuits the functional neuroanatomy of the central executive. We studied central executive performance in 17 non‐demented, highly selected PD patients, by means of the Brown‐Peterson paradigm (BPP), and correlated the BPP performance according to various response delays (from 0 to 18 s) with local cerebral metabolic rates of glucose. We document for the first time that the BPP performance in PD is heterogeneous not only across delays (with PD patients selectively impaired for the 0 and 3 s delays, compatible with impaired attention and central executive, respectively), but also from subject to subject; a multiple correspondence analysis was able to distinguish two patient subgroups according to short delay BPP performance. The correlational analysis with PET data evidenced a limited number of significant correlations, most of which were consistent with our working hypothesis. Notably, a positive correlation between lateral frontal relative metabolism and BPP performance for short delays, and a negative one between these scores and mediodorsal (MD) thalamic nucleus metabolism, would fit the way in which caudate dopamine denervation would alter in opposite directions frontal cortex and MD nucleus synaptic activity and in turn affect central executive function. The results from this study lend further support to the role of altered thalamo‐prefrontal interplay as the basis for central executive dysf

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00098.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

There is limited experience with continuous (>3 days) isoflurane anesthesia for status epilepticus (SE). We present a case with prolonged SE, probably due to thallium intoxication, in which isoflurane successfully suppressed seizure activity over 7 days without adverse effects. When isoflurane was discontinued, seizures returned despite high doses of barbiturates, and the patient died several months later. Early isoflurane anesthesia is an effective alternative therapy in prolonged convulsive SE resistant to common therapy and intravenous general anesthesia. However, its continuous application for several days requires familiarity with anesthesiologic principles, and scavenging of expiratory air.

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00099.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The records of 18 patients with intractable partial seizures who were observed on an in‐patient epilepsy unit during single drug treatment with carbamezepine (CBZ) or phenytoin (PHT) and during combination therapy with both drugs were evaluated retrospectively. Seizure frequency was significantly lower during combination therapy (p0.10). In addition subjective signs of clinical toiicity (e.g. nausea, ataxia, etc.) increased only slightly during combination versus monotherapy. These findings were consistently seen whether the data were evaluated in total (i.e. treatment periods at least 7 weeks) or evaluated by using standardized 35 day treatment periods. In the absence of a blinded clinical trial evaluating PHT/CBZ combination, these findings support consideration of this combination in Intractable patients who have failed rigorously administered mono‐therapy trials, recognizing however that only a small percentage of patients will improve on combination ther

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00100.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

To ascertain the possible role of iron as a risk factor for cerebral ischemia, we studied the serum levels of iron, transferrin and ferritin in 42 patients between the third and seventh days after a cerebral ischemic event (transient ischemic attack, reversible ischemic neurological deficit or cerebral infarction) and in 62 matched controls. The serum levels of iron did not differ significantly between cerebral ischemic patient and control groups. Serum transferrin levels were lower and ferritin higher in stroke patients than in controls. These values were not influenced by age, blood pressure, or smoking and alcohol drinking habits. These results suggest that iron stores could be related to the risk for cerebral ischemia.

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00101.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Selenium is an essential component of the antioxidant enzyme glutathione peroxidase. The activity of this enzyme is reduced in the substantia nigra of patients with Parkinson's disease (PD), but the results of studies on erythrocytes are controversial. We compared the serum levels of selenium and the 24 h urinary selenium excretion (measured by hydride generation atomic absorption spectrophotometry) in 29 PD patients and 30 matched controls. Serum selenium levels were significantly lower in PD patients than in controls (34.6 ± 2.35 and 45.2 ± 3.83 μg/l,p<0.05) while urinary excretion was similar for both groups (47.1 ± 6.25 and 45.5 ± 5.38 μg/24 h). These values were not influenced by antiparkinsonian drugs, and they did not correlate with age, age at onset and duration of the PD, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group. These results might suggest a possible role of low serum selenium levels in the risk for, or a consequence of the oxidative stress

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00102.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We have studied habituation of the pattern‐reversal visual evoked potential (VEP) in healthy volunteers (n= 16) and in patients suffering from migraine without (n= 27) or with aura (n= 9). Five blocks of 50 responses at a stimulation rate of 3.1 Hz were sequentially averaged and analyzed separately for latencies, peak‐to‐peak amplitudes of N1‐P1 and P1‐N2, and the area under the N2 component Latencies of N1, P1, or N2 components were not significantly different between the sequential trial blocks, or between groups. Mean amplitudes of N1‐P1 and P1‐N2 in the first and subsequent blocks of SO responses were not statistically different among groups. In healthy subjects, there was a decrement of N1‐P1 and P1‐N2 amplitudes and N2 area on successive averagings. This habituation was maximal in the third and fourth blocks, but tended to disappear in the fifth block. In marked contrast to healthy subjects, migraine patients were characterized by a transient amplitude increment (i.e. potentiation) of VEP components which reached its maximum in the second to fourth blocks. Amplitude changes in sequential blocks were not dependent on attention and differed significantly between healthy subjects and migraineurs, but not between migraine with and without aura. Taken together with previous studies showing deficient habituation of contingent negative variation in migraine, these results indicate a dysfunction of central information processing which might have behavioral and path

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00103.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Brucellosis is a systemic infection that rarely involves the nervous system. This paper describes 21 cases of neurobrucellosis affecting different parts of the peripheral and central nervous system. The various presentations closely simulated acute meningoencephalitis, myelitis, cerebral ischaemia, radiculopathy or multisystem degeneration. All patients received adequate combined antimicrobial therapy of trimethroprim‐sulfamethoxazole, doxycycline, and/or rifampicin. The improvement was quick and complete in meningoencephalitic patients, while others with structural changes in the nervous system did not recover and ended up with permanent deficits. The combination regimen and duration of therapy are the focus of this stud

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00104.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We describe a parkinsonian patient who developed a slight asymptomatic pleural effusion during prolonged therapy with low dose bromocriptine (BCR) in addition to levodopa, following prior treatment with CQA 206–291. A moderate increase of BCR dosage prompted a severe pleuropulmonary inflammatory reaction with polyclonal activation and elevated serum liver enzymes, which normalized following withdrawal of the drug. The clinical syndrome and close relation to BCR treatment are in keeping with a diagnosis of BCR‐related pleuropulmonary fibrosis (PPF). Features of this case are compared with previous reports on dopamine (DA) agonist‐related PPF. This case supports earlier suggestions of polyclonal activation in DA agonist‐related PPF and suggests hepatic involvement and dose dep

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00105.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Twenty‐eight adult patients with mitochondrial disease were evaluated with muitimodal evoked potentials (EPs) to assess a possible CNS involvement The patients were classified into five groups: encephalopathy (two cases), progressive external ophthalmoplegia (PEO; four cases), pure myopatby (15 cases), cardiomyopathy (five cases) and asymptomatic relatives (two cases). EPs showed differences between encephalopathy (all EP modalities affected) and PEO groups (all patients with at least one EP altered), with lesser degrees of affection in pure myopathy and cardiomyopathy groups. The asymptomatics registered normal EPs. In view of these results, progressive CNS damage in mitochondriopathies, expressed by abnormal EPs, can be established as follows (from greatest to minor severity): encephalopathy, PEO, pure myopathy/cardiomyopathy and asymptomatic conditio

ISSN:1351-5101    

DOI:10.1111/j.1468-1331.1995.tb00106.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY